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Detecting change in patients with stroke using the Berg Balance Scale
1Rehabilitation Services, St Boniface General Hospital, Winnipeg, Manitoba, R2H 2A6, Canada. tstevens@sbgh.mb.ca
The Australian Journal of Physiotherapy
|September 13, 2001
Summary
A change of +/- 6 points on the Berg Balance Scale (BBS) indicates genuine improvement in functional balance. However, this statistical measure only agreed with clinicians' perceptions in about half of stroke rehabilitation patients.
Area of Science:
- Rehabilitation Medicine
- Gerontology
- Neurology
Background:
- The Berg Balance Scale (BBS) is a standard tool for assessing functional standing balance.
- Determining the minimum detectable change (MDC) is crucial for interpreting BBS score changes in clinical practice.
- Understanding the MDC helps differentiate true functional improvements from measurement error.
Purpose of the Study:
- To estimate the Minimum Detectable Change (MDC) for the Berg Balance Scale (BBS) using the Standard Error of Measure (SEM).
- To assess the agreement between the statistically derived MDC and clinicians' perceptions of genuine change in functional balance.
- To evaluate the validity of the SEM/MDC methodology for determining a criterion BBS change value.
Main Methods:
- The study involved 48 subjects undergoing inpatient rehabilitation after a stroke.
- Two raters administered the BBS to each subject on consecutive days.
- Minimum Detectable Change (MDC) was calculated using the Standard Error of Measure (SEM).
- Agreement between MDC and clinician judgment of change was analyzed.
Main Results:
- The MDC analysis indicated that a change of +/- 6 BBS points is required for 90% confidence in detecting genuine change.
- Agreement between the statistically derived presence of change (MDC) and clinicians' perceptions was observed in only 25 out of 45 subjects (55.6%).
Conclusions:
- A change of +/- 6 points on the BBS is suggested as the threshold for reliable detection of functional balance change in stroke patients.
- The significant lack of agreement between the MDC and clinician perception highlights potential limitations.
- Further investigation is needed to understand discrepancies, possibly related to SEM/MDC methodology, patient heterogeneity, or clinician assessment subjectivity.